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Approximately 1.6 million children and adults were living with HIV in 2001 in the WHO European Region, and estimations suggest that this number increased to 2.3 million people in 2011 and is still rising. Alarmingly, around half of those people do not know that they are infected.

Despite the progress in achieving universal access to HIV prevention, treatment, care and support across the Region over the last decade, the response to HIV epidemic still faces many challenges.

• Unknown HIV status: Because of low access to and uptake of HIV testing and counselling, especially among the populations most at risk of infection and transmission, all HIV cases in Europe are not diagnosed. No country knows exactly how many infected people it has within its borders, making it difficult for the health system to offer appropriate scale of medical services, including medical treatment and care.
• Late treatment initiation: For HIV combination therapy to work, it is best started at a time when the patient is still relatively healthy. Unfortunately, many Europeans with HIV start treatment too late and already show signs of widespread immune system damage, leading to excess morbidity and mortality.
• Low access to treatment: Access to life-saving antiretroviral therapy is inadequate in a number of European countries; as a result, patients who need the therapy often do not receive it. Lack of access to treatment reduces the incentive to get tested, as does fear of discrimination and stigmatization. In eastern Europe and central Asia, only 25% of those believed to need antiretroviral treatment were receiving it in 2011.
• Coinfection with tuberculosis: TB remains one of the leading causes of death among people who live with HIV. The risk of developing TB is far greater for people living with HIV if the infection is not treated. For this reason, the incidence of TB will likely continue to rise in eastern Europe.
• Coinfection with hepatitis: More than half of the estimated 2.3 million people living with HIV are also chronically infected with the hepatitis C virus (HCV). The people most at risk of HIV/HCV coinfection are people who inject drugs and men who have sex with men. Coinfection can lead to life-threatening liver failure. Hepatitis is difficult and costly to treat, and this situation is likely to lead to tens of thousands of unnecessary deaths in the years to come.